Document Detail

Comparison of transperitoneal and retroperitoneal approaches in abdominal aortic surgery.
MedLine Citation:
PMID:  19051466     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: The transperitoneal approach (TP) to the aorta is the most widely accepted surgical approach in aortic surgery as it is simple, fast and provides excellent exposure of the intra-abdominal cavity and vascular structures. In recent years, there has been an increasing interest in the retroperitoneal (RP) approach to the aorta since it has been described as having a better outcome, i.e., preserving pulmonary function and gastro-intestinal physiology, reducing the intra-operative blood loss, minimising patient discomfort or pain, decreasing the incidence of wound complications and shortening ICU and hospital stay. The aim of this study is to compare the transperitoneal and retroperitoneal approaches in aortic surgery for aorto-iliac occlusive disease (AIOD). METHODS: From December 2003 to June 2006, a total of 153 consecutive patients who had undergone aortic surgery for AIOD, were studied retrospectively. The TP approach was used in 85 patients and the RP approach in 68 patients. Demographic features, intra-operative and postoperative data were analysed and compared according to the approach used. RESULTS: The mean operating time (83.6 +/- 23 vs. 104.4 +/- 30 min, p < 0.001) and mean aortic cross-clamp time (18.4 +/- 3 vs. 15.2 +/- 3 min, p < 0.0412) were significantly longer in the RP group. Peri-operative blood loss (700 +/- 350 vs. 650 +/- 330 ml, p < 0.683) and mortality rate < or = 30 day (1/1.2% vs. 0/0.0%, p < 0.896) were similar between the groups. The operative 30 day mortality rate was 0.7% (1 of 153) overall. The RP group had an earlier return of bowel functions (17.1 < or = 3 vs. 24.2 < or = 5 hrs, p < 0.001), earlier resumption of diet (26.4 < or = 4 vs. 31.4 < or = 5 hrs, p < 0.001), shorter period of intubation (3.5 < or = 2 vs. 6.5 < or = 3 hrs, p < 0.001), ICU stay (1.5 < or = 1 vs. 4.2 < or = 1 hrs, p < 0.001) and hospital stay (4.0 < or = 1 vs. 5.9 < or = 1 days, p < 0.001). Mean effort-pain scores were significantly lower in the RP group (3.8 < or = 1 vs. 5.3 < or = 1, p < 0.001). Incidence of pulmonary complications (4.4%, 3 of 68 vs. 7.3%, 8 of 85, p < 0.001), paralytic ileus (1.5%, 1 of 68 vs. 3.5%. 3 of 85, p < 0.001) were also lower in the RP group. Wound complications were more common in the TP group (4.7%, 4 of 85 vs. 10.3%, 7 of 86, p < 0.001). Most cases in both groups were related to incisional hernia or evisceration. CONCLUSION: This report presents our experience with the use of TP and RP approaches in a patient population merely consisting of AIOD. The RP approach was associated with a significantly lower incidence of postoperative pulmonary complications, rapid recovery of gastro-intestinal functions, shorter ICU and hospital stay, less peri-operative blood loss and lower mean effort-pain scores. We conclude that the RP approach is a safe and feasible technique that exposes patients to less postoperative complications.
Y Kalko; M Ugurlucan; M Basaran; E Nargileci; M Banach; U Alpagut; T Yasar
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Acta chirurgica Belgica     Volume:  108     ISSN:  0001-5458     ISO Abbreviation:  Acta Chir. Belg.     Publication Date:    2008 Sep-Oct
Date Detail:
Created Date:  2008-12-04     Completed Date:  2009-02-10     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0370571     Medline TA:  Acta Chir Belg     Country:  Belgium    
Other Details:
Languages:  eng     Pagination:  557-62     Citation Subset:  IM    
Department of Cardiovascular Surgery, SB Vakif Gureba Hospital, Istanbul, Turkey.
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MeSH Terms
Aorta, Abdominal / surgery*
Arterial Occlusive Diseases / surgery*
Blood Loss, Surgical
Intestinal Pseudo-Obstruction / etiology
Length of Stay
Middle Aged
Pain Measurement
Pneumonia / etiology
Postoperative Complications
Recovery of Function
Respiratory Insufficiency / etiology
Retrospective Studies
Time Factors
Vascular Surgical Procedures / methods*

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